责任段减压融合治疗腰椎退变侧弯椎管狭窄  

Decompression and instrumented fusion of responsible segments for degenerative lumbar scoliosis

作　　者：禹志军 白曼莫[1] 王锋 YU Zhi-jun;BAI Manmo;WANG Feng(Traditional Chinese Medicine Hospital of Sanya City,Guangzhou University of Traditional Chinese Medicine,Sanya 572000,China)

机构地区：[1]广州中医药大学附属三亚市中医院,海南三亚572000

出　　处：《中国矫形外科杂志》2021年第3期202-206,共5页Orthopedic Journal of China

摘　　要：[目的]评价责任节段减压固定融合治疗腰椎管狭窄症(lumbar spinal stenosis,LSS)合并退行性腰椎侧凸(degenera⁃tive lumbar scoliosis,DLS)的临床效果。[方法]回顾性分析本院2015年1月~2019年12月手术治疗LSS合并DLS 88例患者的临床资料,其中,46例行责任节段减压固定融合治疗,42例行单纯减压术。比较两组围手术期、随访和影像资料。[结果]两组患者的手术时间、术中出血量、切口长度、术后引流量、住院时间和住院费用等差异较小(P>0.05)。所有患者随访22~62个月,平均(43.52±4.41)个月。与术前相比,末次随访时两组患者的腰痛和腿痛VAS评分,以及ODI评分均显著降低(P<0.05)。末次随访时,减压融合组患者的腰痛和腿痛VAS评分,以及ODI评分均显著低于单纯减压组(P<0.05)。影像方面,末次随访时两组患者侧凸Cobb角、顶椎侧偏度、冠状面平衡、骨盆倾斜角和矢状面平衡均较术前显著减小,而腰椎前凸角显著增加(P<0.05)。末次随访时,减压融合组上述指标均显著优于单纯减压组(P<0.05)。[结论]责任节段减压融合术具有简便、安全、高效的优势,对于LSS合并DLS有较好的临床疗效。[Objective]To evaluate the clinical outcomes of responsible-segment decompression and instrumented fusion for lumbar spinal stenosis combined with degenerative lumbar scoliosis(LSS-DLS).[Methods]A retrospective study was done on 88 patients who un⁃derwent surgical treatment for LSS-DLS from January 2015 to December 2019 in our hospital.Of them,46 patients received responsiblesegment decompression and instrumented fusion,while the remaining 42 patients had responsible-segment decompression only performed.The perioperative,follow-up and radiographic documents were compared between the two groups.[Results]There were little differences in operation time,intraoperative blood loss,incision length,postoperative drainage volume,hospitalization time and hospitalization expenses between the two groups(P>0.05).All the patients were followed up for 22 to 62 months with a mean of(43.52±4.41)months.The VAS scores for low back pain and leg pain,as well as ODI score significantly dreacesed at the latest follow-up compared with those before opera⁃tion in both groups(P<0.05).The decompression-fusion group was significantly superior to the decompression-only group in the VAS and ODI scores at the latest follow-up(P<0.05).With regard to radiographic assessment,the scoliotic Cobb's angle,apical vertebra translation(AVT),coronal vertebral axis(CVA),pelvic tilt(PT)and sagittal vertical axis(SVA)significantly decreased,whereas the lumbar lordosis(LL)significantly increased at the latest follow up compared with those before operation in both groups(P<0.05).At the latest follow up,the decompression-fusion group was significantly superior to the decompression-only group regarding aforesaid radiographic parameters(P<0.05).[Conclusion]The responsible-segment decompression and instrumented fusion have the advantages of simplicity,safety and high ef⁃ficiency,and achieve satisfactory clinical outcomes for LSS-DLS.

关 键 词：责任节段减压融合治疗 腰椎退变性侧弯 腰椎椎管狭窄症 临床疗效 

分 类 号：R681.57[医药卫生—骨科学]